Strengthening the Prevention, Detection, and Treatment of Diseases affecting US-bound Refugees and Other Globally Mobile Populations

加强对影响赴美难民和其他全球流动人口的疾病的预防、检测和治疗

• 批准号: 9791337
• 负责人: Alexander Klosovsky
• 金额: --
• 依托单位: INTERNATIONAL ORGANIZATION FOR MIGRATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9791337
• 关键词: Strengthening; Prevention; Detection; Treatment; Diseases

OVERALL PROJECT SUMMARY Under technical guidance the Centers for Disease Control and Prevention, the Migration Health Division of the International Organization for Migration (IOM) performs essential pre-departure activities for U.S.-bound refugees and immigrants to ensure they are fit to travel, that they receive cost-effective public health interventions, and that communicable diseases of public health significance are identified, managed, and reported. These activities comprise health assessments, which include screening and treatment for tuberculosis (TB) and other infectious diseases, additional evaluations for those with significant medical conditions, vaccinations and presumptive treatment, pre-embarkation checks, and outbreak response. As global mobility continues to accelerate, improved understanding, prevention, detection, and treatment of diseases affecting such populations is increasingly important for the health of individuals and communities. We propose to three activities with the overall goal of strengthening pre-departure procedures and disease prevention and control (see appendix attachment for summaries): (A) Diagnosis and Follow-up of Plasmodium malariae Infections in U.S.-bound Refugees to Inform Presumptive Treatment Recommendations. Presumptive artemisinin-based combination therapy (ACT) is recommended for all U.S.-bound refugees from Sub-Saharan Africa prior to departure. Although thought to be effective against P. malariae, recent data suggest it may be inadequate. We will determine rates of ACT success against P. malaraiae in U.S.-bound refugees in Uganda, and other considerations to inform pre-departure guidelines. (B) Latent Tuberculosis Infection (LTBI) Testing and Voluntary Treatment for U.S.-Bound Refugees in Tanzania and U.S.-Bound Immigrants in Vietnam. A substantial number of immigrants and refugees arriving in the U.S. may have undiagnosed and untreated LTBI and some will go on to develop active TB disease. Given that LTBI treatment initiation and completion rates for refugees and immigrants after arrival in the U.S. are suboptimal, new strategies are wanted. We will assess the acceptability and feasibility of offering LTBI testing and treatment overseas during the health assessment. (C) A Rapid Point-of-Care Testing Strategy to Increase Presumptive Strongyloides Treatment of U.S.-bound Refugees in Sub-Saharan Africa. Standard diagnostics for Loa loa infection require laboratory testing that is not readily available. Many U.S.-bound refugees cannot be tested for loaisis and thus must be excluded from presumptive treatment for strongyloidiasis, putting them at risk for serious long-term sequelae. We will investigate the use of a smart phone-based microscope as a point-of-care test for loaisis. Together, these activities will contribute to protecting and improving the health of U.S.-bound refugees and immigrants, identifying best practices and provide evidence-based strategies for disease prevention and control, and reducing the risk of infectious disease importation into the U.S.

总体项目摘要 在疾病控制和预防中心的技术指导下， 国际移民组织（IOM）为美国人提供必要的出发前活动，约束 难民和移民，以确保他们适合旅行，他们获得具有成本效益的公共卫生 干预措施，并确定，管理， 报道这些活动包括健康评估，其中包括筛查和治疗 结核病（TB）和其他传染病，对那些有重大医疗 条件、疫苗接种和假定治疗、登机前检查和疫情应对。作为 全球流动性继续加速，提高了对艾滋病的理解、预防、检测和治疗。 影响这些人口的疾病对个人和社区的健康越来越重要。 我们建议开展三项活动，总目标是加强离境前程序和疾病预防 预防和控制（摘要见附件）：（A）疟原虫的诊断和随访 美国的疟疾感染-有义务向难民通报推定治疗建议。推定 青蒿素为基础的联合治疗（ACT）被推荐用于所有美国-来自撒哈拉以南非洲的难民 出发前的非洲虽然被认为对三日疟原虫有效，但最近的数据表明， 不足我们将确定ACT在美国对抗疟疾疟原虫的成功率-在乌干达的难民， 和其他考虑因素，以告知出发前的指导方针。(B)潜伏性结核感染（LTBI）检测 和自愿治疗美国-坦桑尼亚和美国的难民-越南的绑定移民。一 抵达美国的大量移民和难民可能患有未确诊和未经治疗的LTBI 有些人会发展成活动性结核病鉴于LTBI治疗的开始和完成率 难民和移民抵达美国后是次优的，需要新的策略。我们将评估 在健康评估期间提供海外LTBI测试和治疗的可接受性和可行性。（丙） 一种快速的即时检测策略，以增加美国的推定类圆线虫治疗-约束 撒哈拉以南非洲的难民。Loa loa感染的标准诊断需要实验室检测， 不容易获得。许多美国-受约束的难民不能进行Loaisis测试，因此必须被排除在 推定治疗类圆线虫病，使他们面临严重的长期后遗症的风险。我们将 研究使用基于智能手机的显微镜作为loaisis的即时检测。 总之，这些活动将有助于保护和改善美国的健康。被困难民和 移民，确定最佳做法，并提供基于证据的疾病预防战略， 控制，并降低传染病输入美国的风险。